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Antioxidants are abundant in blueberries, and while there are many studies concerning the bioactive compound of fruit, it is only recently that the wild Vaccinium species has attracted attention for their diverse and abundant chemical components. The aim of this study was to investigate the bioactive compounds of blueberry cultivars and wild species found in Japan. Among the five extracts of the Vaccinium species, Natsuhaze (Vaccinium oldhamii Miq.) was found to be the most effective at inhibiting the growth of HL-60 human leukemia cells in vitro. Although all ethanol extracts showed a growth inhibitory effect on HL-60 cells, the degree of the effects differed among the species. The extract of Natsuhaze induced apoptotic bodies and nucleosomal DNA fragmentation in the HL-60 cells. Of the extracts tested, that of Natsuhaze contained the largest amount of total polyphenols and showed the greatest antioxidant activity, but the anthocyanin content of Natsuhaze was similar to that of rabbiteye blueberry (V. virgatum Ait.). The results showed that total polyphenols contributed to the high antioxidant activity and growth inhibitory effect on HL-60 human leukemia cells of Natsuhaze extract.

Since its introduction in 1983, transanal endoscopic microsurgery (TEM) has emerged as a safe and effective method to treat rectal lesions including benign tumors, early rectal cancer, and rectal fistulas and strictures. This minimally invasive technique offers the advantages of superior visualization of the lesion and greater access to proximal lesions with lower margin positivity and specimen fragmentation and lower long-term recurrence rates over traditional transanal excision. In addition, over two decades of scientific data support the use of TEM as a viable alternative to radical excision of the rectum with less morbidity, faster recovery, and greater potential cost savings when performed at specialized centers.

Purpose: National Surgical Adjuvant Breast and Bowel Project (NSABP) protocol LTS-01 examines routine preventive care and cancer surveillance in long-term colorectal cancer (CRC) survivors previously treated in NSABP adjuvant trials., Patients and Methods: Long-term CRC survivors (≥5 years) from five completed NSABP trials (Protocols C-05, C-06, C-07, R-02, and R-03) at 60 study sites were recruited and surveyed using preventive health care items from the National Health Interview Survey (NHIS). A 3:1 comparison cohort case-matched by age, sex, race, and education was created from the 2005 NHIS. Contingency tables and multivariate models were used to compare cohorts and determine predictors of preventive care and cancer surveillance., Results: A total of 708 patients in protocol LTS-01 (681 patients with colon cancer, 27 patients with rectal cancer) completed the interview: 57.1% male, mean age 66.2 years (standard deviation=10.6), median survival 8 years. Patients in the LTS-01 protocol were more likely to have a usual source of health care (97.7% v 93.8%, P<.0001), have received a flu shot in the past 12 months (67.5% v 44.3%, P<.0001), and have undergone cancer screening by Pap smear (67.3% v 54.8%, P<.0001), mammogram (80.4% v 70.7%, P<.0001), and prostate-specific antigen test (84.5% v 74.5%, P<.0001) than patients in the NHIS cohort. For CRC surveillance, 96.5% of patients in protocol LTS-01 had a colonoscopy, 88.2% had a carcinoembryonic antigen test, and 66.4% had a computed tomography scan in the previous 5 years. Health insurance was the best predictor of cancer screening for all three methods (odds ratio=2.6 to 4.5). No factor was uniformly associated with CRC surveillance., Conclusion: This select population of long-term CRC survivors who participated in clinical trials achieved better routine preventive care and cancer screening than the general population and high rates of cancer surveillance.

Purpose: Octogenarians and nonagenarians constitute a rapidly growing segment of patients undergoing colorectal cancer resection. We describe their outcomes in a large population cohort and aim to establish expectations and improvements for their care., Methods: All patients undergoing surgical resection for colorectal cancer in California (1994-2005) were identified in the California Cancer Registry, which was linked with the California Office of Statewide Health Planning and Development Patient Discharge Database and the 2000 United States Census. Multivariate logistic regression was used to determine significant outcome predictors., Results: Octogenarians and nonagenarians comprised 26% of all patients undergoing colon cancer resection and 16% of all patients undergoing rectal cancer resection from 1994 to 2005. This cohort had more comorbidities but less distant disease than patients <65 years old (P < .001). Twelve percent of patients with rectal cancer and 17% of patients with colon cancer who were 80 years or older had emergent surgery vs 5% and 12%, respectively, for patients <65 years old (P < .001). Patients 80 years or older had nearly twice the readmission incidence rate (417 readmissions per thousand patient-years) of patients <65 years old. Twenty-seven percent of 90-day readmissions were for surgical complications, 52% of which required a subsequent procedure. Patients 80 years or older had high in-hospital mortality (6%) and one-year mortality (29%). Medical complications, increasing comorbidities, and cancer stage were predictive of in-hospital and 1-year mortality., Conclusions: : Octogenarians and nonagenarians represent a large segment of patients with colorectal cancer undergoing surgical resection with high rates of morbidity, mortality, and readmission. Medical optimization and excellent continuity of care may contribute to improved outcomes following surgery for these complex patients.

Introduction: A recent study has raised concerns that infliximab treatment, by postpoing surgery for ulcerative and indeterminate colitis patients, may result in a greater need for high-risk emergent or multistep surgical procedures (subtotal colectomies). Our aim was to assess whether infliximab exposure affects rates of subotal colectomy in a large cohort of patients., Methods: We evaluated 171 consecutive patients with ulcerative or indeterminate colitis who had a total proctocolectomy or a subtotal colectomy between 1993 and 2006 for symptoms of unremitting disease. Forty-four patients (25.7%) received infliximab prior to surgery. We compared the surgical procedures employed on these 44 patients to the surgical procedures employed on the 127 non-infliximab patients, using Fisher's exact or Student's t test., Results: Infliximab exposure did not appear to affect the rate of emergent surgery (4.5% vs 4.4%, p = 0.98), rate of subtotal colectomy (19.2% vs. 18.0%, p = 0.99), or rate of ileoanal J pouch reconstruction (53.8% vs. 62%, p = 0.98). Nor did it affect intraoperative findings of perforation, toxic megacolon, and active disease. The infliximab and non-infliximab cohorts were similar in age, Charlson Comorbidity Index, concomitant steroid use, and albumin levels, although infliximab patients had higher rates of concomitant exposure to 6-mercaptopurine (34.1% vs 16.6%, p = 0.02) and azathioprine (40.9% vs 22.6%, p = 0.02)., Conclusion: Infliximab does not appear to increase rates of emergent surgery or multistep procedures in patients undergoing treatment for ulcerative or indeterminative colitis at our institution.

Purpose: The impact of infliximab (IFX) on postoperative complications in surgical patients with Crohn's disease (CD) and ulcerative colitis (UC) is unclear. We examined a large patient cohort to clarify whether a relationship exists between IFX and postoperative complications., Methods: A total of 413 consecutive patients--188 (45.5%) with suspected CD, 156 (37.8%) with UC, and 69 (16.7%) with indeterminate colitis--underwent abdominal surgery at the Massachusetts General Hospital between January 1993 and June 2007. One hundred one (24.5%) had received preoperative IFX < or = 12 weeks before surgery. These patients were compared to those who did not receive IFX with respect to demographics, comorbidities, presence of preoperative infections, steroid use, and nutritional status. We then compared the cumulative rate of complications for each group, which included deaths, anastomotic leak, infection, thrombotic complications, prolonged ileus/small bowel obstruction, cardiac, and hepatorenal complications. Potential risk factors for infectious complications including preexisting infection, pathological diagnosis, and steroid or IFX exposure were further evaluated using logistic regression analysis., Results: Patients were similar with respect to gender (IFX = 40.6% men vs. non-IFX = 51.9%, p = 0.06), age (36.1 years vs. 37.8, p = 0.43), Charlson Comorbidity Index (5.3 vs. 5.7, p = 0.25), concomitant steroids (75.3% vs. 76.9%, p = 0.79), preoperative albumin level (3.3 vs. 3.2, p = 0.36), and rate of emergent surgery (3.0% vs. 3.5%, p = 1.00). IFX patients had higher rates of CD (56.4% vs. 41.9%, p = 0.02), concomitant azathioprine/6-mercaptopurine use (34.6% vs. 16.6%, p < 0.0001), and lower rates of intra-abdominal abscess (3.9% vs. 11%, p < 0.05). After surgery, the two groups had similar rates of death (2% vs. 0.3% p = 0.09), anastomotic leak (3.0% vs. 2.9%, p = 0.97), cumulative infections (5.97% vs. 10.1%, p = 1), thrombotic complications (3.6% vs. 3.0%, p = 0.06), prolonged ileus/small bowel obstructions (3.9 vs. 2.8, p = 0.59), cardiac complications (1% vs. 0.6%, p = 0.42), and hepatic or renal complications (1.0 vs. 0.6% p = 0.72). A logistic regression model was then created to assess the impact of IFX, as well as other potential risk factors, on the rates of cumulative postoperative infections. We found that steroids (odds ratio [OR] = 1.2, p = 0.74), IFX (OR 2.5, p = 0.14), preoperative diagnosis of CD (OR = 0.7, p = 0.63) or UC (OR = 0.6, p = 0.48), and preoperative infection (OR = 1.2, p = 0.76) did not affect rates of clinically important postoperative infections., Conclusions: Preoperative IFX was not associated with an increased rate of cumulative postoperative complications.

Susabinori (Porphyra yezoensis), a red alga, is cultured and processed into a sheet-style dried food, nori, in Japan. But significant amounts of cultured susabinori, which has a low protein content is discarded because of its low quality. The protein content of nori has been reported to be correlated inversely with the carbohydrate content. In this study, we examined the relationship between the protein content and the fermentation of nori by means of bfidobacteria. nori with a low protein content (25% on dry base) was strongly fermented by bifidobacteria, whereas nori with a high protein content (41% on dry base) was not. nori with a low protein content contained large amounts of glycerol galactoside (GG, floridoside: 2-O-glycerol-alpha-D-galactoside, isofloridoside: 1-O-glycerol-alpha-D-galactoside), more than 10% w/w in the dried condition, and GG was the main substrate for fermentation by bifidobacteria. GG was not digested by digestive enzymes, and was not absorbed in the small intestine. These results suggest that GG can be used as a substrate for fermentation by bifidobacteria, and possibility of GG as a prebiotic.

Objective: To analyze use of combined liver and kidney transplantation (CLKT) for patients with chronic primary diseases of both organs and for patients with hepatorenal syndrome., Design: Retrospective case series., Setting: Multiorgan transplantation service in a large university medical center., Patients: A total of 98 patients underwent 99 CLKTs during a 16-year period; 76 had primary renal diseases, and 22 had hepatorenal syndrome. Patients receiving isolated liver and kidney transplants were analyzed for comparison., Main Outcome Measures: Patient and graft survival, rejection rates, and need for hemodialysis before and after transplantation., Results: Overall patient survival was 76%, 72%, and 70% at 1, 3, and 5 years, respectively; liver graft survival was 70%, 65%, and 65%; and kidney graft survival was 76%, 72%, and 70%. No risk factors analyzed for recipients or donors were associated significantly with early posttransplantation mortality or graft loss. In 28 patients who received monoclonal antibody induction therapy with interleukin 2 blockers, there were significantly fewer episodes of acute liver rejection. For patients with hepatorenal syndrome, CLKT did not confer a survival advantage over liver-only transplantation (1-year patient survival was 72% vs 66%; P = .88). The 1-year acute kidney rejection rate in the adult CLKT group was 14% vs 23% in a 5-year cadaveric renal transplantation cohort (P<.01)., Conclusions: First, CLKT is indicated in patients with dual organ disease and achieves excellent results. Second, CLKT for hepatorenal syndrome is indicated in patients receiving hemodialysis for longer than 8 weeks and confers advantages in patient survival and use of hospital resources. Third, the liver is immunoprotective for the kidney.

Immunosuppression after heart transplantation is implicated in development of post-transplant lymphoproliferative disorder (PTLD). Despite a higher prevalence of PTLD in children, there is scarce knowledge about incidence, pathophysiologic mechanisms and risk factors for PTLD in pediatric recipients of cardiac allografts. We examined retrospectively the medical records of all 143 pediatric patients (mean age 9.2 +/- 6.1 yr) who received donor allografts between 1984 and 2002 and survived over 30 days. Five children (3.5%) developed PTLD over a mean follow-up period of 41.1 +/- 46.0 months. Time from transplant to diagnosis of PTLD ranged from 3.9 to 112 months (mean 48.0 +/- 41.9 months). Excluding PTLD, no other malignancies were found in this population. Actuarial freedom from PTLD was 99.2%, 99.2% and 96.2% at 1, 2, and 5 yr, respectively. Children who developed PTLD were more likely (by univariate analysis) to have been Rh negative (p = 0.01), Rh mismatched (p = 0.003), Epstein-Barr virus (EBV) seronegative (p = 0.001) and transplanted for congenital heart disease (p < 0.02). PTLD was associated with significant morbidity and mortality with a mean survival following diagnosis of 21.2 months. PTLD is a serious complicating outcome of cardiac transplantation that occurs in approximately 3.5% of children. Aside of immunosuppression, risk factors in this series for developing PTLD include EBV seronegativity and Rh negative status and mismatch. Non-hematogenous malignancies are rare in light of short allograft half-life.

Protoplasts were isolated from embryogenic calli of Asparagus officinalis L. cv. Mary Washington and cultured in 1/2 MS medium with 1 mg/l NAA, 0.5 mg/l zeatin, 1 g/l L-glutamine, 0.6 M glucose and 0.1% Gellan Gum. Protoplasts started to divide after 3-4 d of culture and formed visible colonies after 30 d of culture. The percentage of colony formation (plating efficiency) was 7.2%. The colonies were then transferred onto Gellan Gum-solidified MS medium containing 1 mg/l 2,4-D and 3% sucrose for further growth. Somatic embryos were induced from all colonies of 0.5-1.0 mm size after transferring to 1/2 MS medium lacking growth regulators. After treating these somatic embryos (1-3 mm) in distilled water for a week, 30-40% of them germinated normally and grew into plantlets 20-30 d after transplanting on 1/2 MS medium containing 1 mg/l IBA, 1 mg/l GA3 and 1% sucrose. These protoplast-derived plants were diploid with 20 chromosomes.